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Ann Thorac Surg 1993;55:883-887
© 1993 The Society of Thoracic Surgeons

Articles

Exercise coronary flow reserve of bilateral internal thoracic artery bypass grafts

Ryuichi Morita, MD*, Soichiro Kitamura, MD, Kanji Kawachi, MD, Tetsuji Kawata, MD, Kazumi Mizuguchi, MD, Yoichi Kameda, MD, Jyunichi Hasegawa, MD, Yoshitsugu Yoshida, MD

Department of Surgery III, Nara Medical College, Nara, Japan

Accepted for publication July 16, 1992.

* Address reprint requests to Dr Morita, Department of Surgery III, Nara Medical College, 840 Shijo-cho, Kashihara, Nara, Japan 634.

We attempted to quantify the exercise coronary flow reserve in 20 patients with bilateral internal thoracic artery grafts to the left coronary arteries (group I) who had complete revascularization. The coronary sinus blood flow was measured by the continuous thermodilution method both at rest and during exercise (50 W for 8 to 9 minutes) approximately 1 month after the operation. These results were compared with 30 patients treated with an internal thoracic artery and saphenous vein grafts to the left coronary arteries (group II) and 9 patients with saphenous vein grafts alone to the left coronary arteries (group III). There were no differences among the three groups in age, sex, number of vessels involved, heart rate, double products, left ventricular (LV) end-diastolic pressure, LV ejection fraction, LV end-diastolic volume, or LV mass at the time of study. None of the 59 patients in the study had abnormally enlarged LV end-diastolic volume or increased LV mass. The postoperative coronary sinus blood flow per 100 grams of LV mass at rest was similar among the three groups (73.0 ± 26.4 mL/min per 100 g LV mass in group I, 73.4 ± 31.1 nL/min per 100 g LV mass in group II, and 75.9 ± 28.5 mL/min per 100 g LV mass in group III [not significant]) and significantly (p < 0.01) increased by exercise, although the differences between groups during exercise were not significant (158.9 ± 45.9, 153.5 ± 72.1, and 148.3 ± 60.0 mL/min per 100 g LV mass, respectively [not significant]). The incremental ratio of coronary sinus blood flow during exercise was similar for each of the three groups as well (2.20 ± 0.60, 2.14 ± 0.52, and 2.11 ± 0.44, respectively [not significant]). We conclude that the use of bilateral internal thoracic artery grafts to the left coronary arteries can provide sufficient coronary flow reserve even during exercise at 1 month postoperatively. This flow is enough to safely implement complete revascularization of the left coronary artery system, on the condition that the left ventricle is neither markedly enlarged nor hypertrophied.




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